Provider Demographics
NPI:1477789212
Name:HAVEN SPEECH AND SWALLOW SPECIALISTS
Entity Type:Organization
Organization Name:HAVEN SPEECH AND SWALLOW SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:MSCCC-SLP
Authorized Official - Phone:417-693-6816
Mailing Address - Street 1:1709 JAMES RIVER RD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-6724
Mailing Address - Country:US
Mailing Address - Phone:417-693-6816
Mailing Address - Fax:888-550-3518
Practice Address - Street 1:1709 JAMES RIVER RD
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-6724
Practice Address - Country:US
Practice Address - Phone:417-693-6816
Practice Address - Fax:888-550-3518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-08
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004023139235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty